[The effect of different fluids on early fluid resuscitation in septic shock]

Feng Li, Hua Sun, Xu-dong Han
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue, Chinese Critical Care Medicine, Zhongguo Weizhongbing Jijiuyixue 2008, 20 (8): 472-5

OBJECTIVE: To study the effects of different fluids on blood pressure (BP), blood lactate clearance and mortality in patients with septic shock after early fluid resuscitation.

METHODS: Sixty patients were enrolled and randomly divided into four groups according to the fluids used in resuscitation: normal saline (NS) group (15 cases), hydroxyethyl starch (HES) group (15 cases), 4% hypertonic saline solution (4%NaCl) group (15 cases), hypertonic sodium chloride hydroxyethyl starch 40 solution (HSH40) group, (15 cases). Patients of different groups received fluid resuscitation via central vein, at the same time, received the anti-shock treatment. Hemodynamic parameters, blood lactate clearance and mortality in patients were monitored after resuscitation.

RESULTS: The study fluid volume and the total fluid volume in the 4%NaCl group and HSH40 group was lower than that in NS group and HES group significantly (all P<0.01). The mean arterial pressure (MAP) in HSH40 group was significantly higher than in the other three groups 1 hour after the fluid resuscitation (all P<0.01). The 24-hour blood lactate clearance in HSH40 group was also higher than in the other three groups (all P<0.01). The scores of sepsis-related organ failure assessment (SOFA) scores, acute physiology and chronic health evaluation II (APACHE II) scores, and 28-day mortality showed no significant differences among these groups (all P>0.05), but a lowering trend on 28-day mortality could be observed in HSH40 group.

CONCLUSION: The rapid elevation of BP can improve blood lactate clearance in patients with septic shock receiving early fluid resuscitation. Compared with other fluids, HSH40 raises BP more quickly and needs lower total resuscitation volume to achieve the same goal.

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